Homestead_Huot '.e CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
. <= STANDARD / SUPPLEMENTAL DEDUCTION FORM �Qa
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's ,� State Form 5473(R19/1-23)
' '= Prescribed by the Department of Local Government Finance ��
I(We) ak-2,a 1 'L 4- r c O i' t e_y'\ 4-.11.A.Q'}- certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the following described real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
dilate/th''S application is signed, (date of signature). I(We):
Q.-Own.Own. ❑Am(are)buying under recorded contract.
❑Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust.
❑Am(are)the shareholder,partner,or member of the entity that owns the property.
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
Cou Township Taxing District(city,town,township)
Parcel Number Legal Description Is theproperty in question:
12 Real Property ❑Annually Assessed Mobile Home(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
ate— t3- auA-- `!0,0- C)c(D . S (---k- 0 ,2
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claimant Vacating a Homestead'?
0 Yes JO No
Sign}}} re of laima'tt
I hereby certify the above statements are true,correct,and complete. A"-f{
Address of Contact(number and street,city,state,and ZIP code) \ Address of ed Homestead,if any(numb r and street,city.state,and ZIP code)
Ik %1 -. aOO - -i cy - 11.11111
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE I NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1)
Surrounding Residential Improvement
Other Land (2) FILE
Total Land(line 1 plus line 2) (3) li
Residential Improvements or Dwelling (4)
Annually Assessed Mobile/ AUG Q 8
21123
Manufactured Home Garage (5)
Other Improvements (6) G//7jBS Q
Total Improvements(Line 4 through Line 6) (7) N COUNT Y AO
Total Value(Line 3 plus Line 7) (8)
Signature of Assessor Date Signed(date,month,year)
I hereby certify the above is true,correct,and complete.
Verifying Action—Signature of Auditor Date Signed(date,month,year)
STANDARD DEDUCTION ALLOWANCE
20 Pay 20 Lesser of 60%of the assessed value of the homestead or$48,000.
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home that $
is not assessed as real property or to a manufactured home that is not assessed as real property may not
exceed one-half(1/2)of the assessed value of the mobile home or manufactured home.
D3t@
Signal of A_ditor �J Signed(month,day,year)
n,Qc �V ' --
: Original—County Auditor,File
DISTRIBUTIO -Stamped Copy—Taxpayer
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